-  1  c.  o  I  Or 

The  Beginning  of  Occupa¬ 
tional  Disease  Reports 


JOHN  B.  ANDREWS' 

Secretary  American  Association  for  Labor  Legislation 
NEW  YORK 


Reprinted  from  The  Journal  of  the  American  Medical  Association 
Dec.  16,  1911,  Vol.  LVII,  pp.  1984-1986 


Copyright,  1911 

American  Medical  Association 
Five  Hundred  and  Thirty-Five  Dearborn  Avenue 
CHICAGO 


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A 


THE  BEGINNING  OF  OCCUPATIONAL 
DISEASE  EEPOETS 


JOHN  B.  ANDREWS 

Secretary  American  Association  for  Labor  Legislation 
NEW  YORK 


In  1911,  for  the  first  time  in  America,  six  states 
enacted  laws  requiring  physicians  to  report  cases  of 
occupational  diseases.  These  states  are  California,  Con¬ 
necticut,  Illinois,  Michigan,  New  York  and  Wisconsin. 
These  laws  have  many  points  in  common,  and  most  com¬ 
monly  the  diseases  to  be  reported  are :  anthrax,  com¬ 
pressed  air  illness,  and  poisoning  from  lead,  phosphorus, 
arsenic  and  mercury  or  their  compounds.  In  Wisconsin, 
for  some  unexplained  reason,  anthrax  is  omitted  from 
this  list,  and  in  Illinois  the  law  is  obscure,  but  appar¬ 
ently  includes  poisoning  from  “sugar  of  lead,  white  lead, 
r.Ndead  chromate,  litharge,  red  lead,  arsenate  of  lead  or 
paris  green,”  and  “the  manufacture  of  brass  or  the 
^smelting  of  lead  or  zinc.” 

In  most  instances  the  notification  by  the  physician  is 
to  include  as  a  minimum  the  name  and  full  postal 
address  and  place  of  employment  of  the  patient,  and  the 
disease.  Michigan  specifically  requires  in  addition,  “the 
length  of  time  of  such  employment,”  and  New  York 
adds,  “with  such  other  and  further  information  as  may 
be  required  by  the  commissioner  of  labor.” 

In  four  states  the  reports  are  to  be  sent  to  the  State 
J  Board  of  Health  and  thereby  transmitted  to  the  depart¬ 
ment  most  directly  interested  in  industrial  inspection 
within  the  state.  In  Connecticut  and  New  York  notifi¬ 
cation  is  direct  to  the  commissioner  of  labor. 

In  every  state  except  Connecticut  there  is  a  penalty 
for  failing  to  report,  but  in  all  states  except  California 
and  Connecticut,  where  a  fee  of  fifty  cents  is  allowed, 
no  compensation  is  paid  for  reports. 

It  is  an  interesting  fact  that  one  of  the  features  of 
this  bill  which  excited  most  comment  among  physicians 
was  the  provision  for  the  payment  of  a  fee  of  fifty  cents 


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for  each  report.  “It  is  an  insult  to  offer  a  medical  man 
a  fee  for  sending  in  a  report  to  the  state/’  exclaimed 
many  physicians,  while  fully  as  many  declared  that  the 
offer  of  fifty  cents  would  result  in  their  sending  in  too 
many  reports. 

This  pioneer  legislation  is  part  of  a  definite  organized 
effort  to  arouse  wider  interest  among  physicians  in  the 
subject  of  industrial  hygiene,  and  to  secure  for  public 
use  a  regular  supply  of  information  .from  those  who 
should  be  best  informed  on  the  subject.  For  this  pur¬ 
pose  a  tentative  bill,  based  on  twelve  years  of  English 
experience,1  was  drafted  and  introduced,  in  1911,  into 
the  legislatures  of  eight  leading  industrial  states.  This 
bill  had  been  passed  unanimously  by  one  house  of  the 
Minnesota  legislature  when  adjournment  postponed 
action  for  two  years.  In  Pennsylvania  some  legal 
experts  added  a  clause  to  one  section  of  the  bill  and  after 
it  had  passed  both  houses  of  the  legislature  the  governor 
vetoed  it  on  the  ground  that  this  particular  new  clause 
made  it  “unconstitutional.”  In  Illinois  where  the  State 
Occupational  Disease  Commission  was  still  at  work,  no 
action  was  taken  by  the  friends  of  the  measure  after 
reaching  an  understanding  that  the  reporting  feature 
would  be  included  in  the  commission’s  bill.  With  the 
slight  local  modifications  already  noted  the  standard  bill 
was  enacted,  and  it  went  into  operation  in  six  states 
during,  the  summer. 

The  educational 'campaign  resulting  in  the  enactment 
of  this  measure  included  the  publication  and  distribution 
of  a  special  four-page  leaflet  on  “Deporting  of  Occupa¬ 
tional  Diseases.”  This  leaflet  included  the  following 
statement : 

When  the  International  Congress  on  Occupational  Diseases 
met  at  Brussels  last  September,  Dr.  Legge,  Medical  Inspector 
of  Factories  in  England,  read  a  paper  on  “Results  of  Ten 
Years’  Notification  of  Lead  Poisoning.”  In  1900  more  than 
1,000  workers  in  that  country  were  reported  as  suffering  from 
this  occupational  poisoning.  Last  year  the  number  was  only 
553,  although  the  system  of  recording  each  case  has  steadily 
improved.  In  some  branches  of  the  dangerous  trades  in  Eng¬ 
land  this  occupational  poison  is  now  only  one-fourth  as  serious 
in  its  effects  as  ten  years  ago. 

1.  On  the  advice  of  expert  medical  authority  in  England  only  a 
few  of  the  most  clearly  defined  and  most  easily  recognizable  of  occu¬ 
pational  diseases  are  included  in  the  beginning.  When  physicians 
have  become  familiar  with  the  purpose  and  the  operation  of  the  law 
its  scope  may  be  extended. 


o 


In  partial  explanation  of  this  striking  improvement 
in  the  conditions  affecting  those  who  work  with  indus¬ 
trial  poisons,  the  leaflet  continues : 

In  Great  Britain  when  a  practicing  physician  observes  in 
a  patient  symptoms  which  lead  him  to  suspect  that  there  is 
suffering  from  industrial  lead,  phosphorus,  mercurial  or  arsen¬ 
ical  poisoning  or  anthrax,  he  is  compelled  under  penalty  by 
the  government  to  report  the  case  to  the  factory  inspector. 
Scientific  men  in  the  public  service  are  then  in  a  position  to 
study  intelligently  the  conditions  which  undermine  health,  to 
suggest  simple,  inexpensive  precautions  to  the  manufacturers 
and  to  instruct  the  work-people  in  the  use  of  measures  for 
the  prevention  of  unnecessary  suffering  and  death. 

Every  class  in  the  community  is  directly  interested  in 
scientific  efforts  to  conserve  the  health,  vitality,  energy  and 
industrial  efficiency  of  wage-earners.  This  interest  is  par¬ 
ticularly  apparent  in  cases  of  suffering  and  inefficiency  due  to 
unliealthful  conditions  of  employment  in  occupations  in  which 
deadly  poisons  are  in  use. 

After  briefly  summarizing  the  causes  and  effects  of 
anthrax,  compressed  air  illness,  and  poisoning  from  lead, 
phosphorus,  mercury  and  arsenic,  the  descriptive  portion 
of  the  leaflet  concludes  as  follows : 

In  order  that  the  necessary  mechanical  and  other  precau¬ 
tions  may  be  taken,  the  state  should  be  enabled  to  determine 
where  and  how  men  are  exposed  to  these  perils.  The  state 
should  be  advised  of  incipient  cases,  so  that  dangerous  condi¬ 
tions  may  be  improved.  English  experience  during  twelve 
years  indicates  that  the  most  practical  and  economical  method 
of  securing  this  information  is  through  the  enactment  of  a 
law  requiring  every  physician  treating  a  case  of  one  of  these 
occupational  diseases  to  report  it  to  the  proper  authority 
precisely  as  he  now  reports  cases  of  contagious  diseases.  From 
the  data  thus  contributed  preventive  and  remedial  measures 
can  be  intelligently  formulated  and  applied.  The  American 
Association  for  Labor  Legislation,  in  its  campaign  for  the 
conservation  of  human  resources,  invites  the  cooperation  of 
other  organizations  in  securing  uniform  legislation  on  this 
subject. 

This  printed  leaflet,  the  final  page  of  which  was  a 
tentative  hill,  was  accompanied  by  additional  literature 
and  circular  letters  and  addressed  to  legislators,  editors 
and  members  of  the  Association  for  Labor  Legislation, 
who  added  their  personal  influence  to  the  campaign,  and 
in  several  instances  appeared  at  legislative  hearings  to 
explain  the  object  of  the  measure. 


4 


From  the  standpoint  of  the  association  the  real  educa¬ 
tional  work  is  merely  begun  with  the  enactment  of  these 
laws.  With  the  arrival  of  the  date  when  each  law  went 
into  effect  a  news  notice  wTas  prepared  for  editorial  use 
in  that  state;  additional  information,  including  copies 
of  the  notification  schedule  now  used  by  physicians  in 
England,  were  furnished  on  request  to  officials  charged 
with  the  law’s  enforcement. 

In  New  York  the  law  was  translated  by  an  Italian 
editor,  and  with  accompanying  explanations  it  was 
widely  republished  among  Italian  readers.  Cases  of 
occupational  poisoning  incidentally  met  with  in  our 
related  investigations  are  now  carefully  noted  and  filed 
for  future  reference,  or  mailed  forthwith  to  the  proper 
state  authority. 

The  desirability  of  the  uniform  reporting  of  industrial 
injuries  in  the  different  states  is  so  apparent  to  those 
who  wish  to  make  intelligent  use  of  such  statistics  rather 
than  to  merely  compile  columns  of  figures,  that  an  effort 
has  already  been  made  to  encourage  the  adoption  of  a 
standard  schedule.2  To  the  rather  meager  information 
specifically  required  as  a  minimum  under  the  various 
laws,  the  state  officials  are  encouraged  to  add  as  many 
facts  as  possible  through  the  use  of  more  elaborate 
blanks  or  by  special  investigations.  One  year’s  experi¬ 
ence  in  securing  this  information  in  half  a  dozen  states 
should  indicate  whether  the  standard  schedule  now  in 
preparation  is  practicable  for  general  use  among  physi¬ 
cians.  Already,  in  several  states,  information  of  great 
significance  has  been  secured  by  state  authorities  under 
this  law,  and  individual  physicians  as  well  as  boards  of 
health  are  preparing  for  the  study  and  prevention  of 
occupational  diseases. 

1  Madison  Avenue. 


2.  A  national  committee  on  standard  schedule  was  appointed 
last  September  and  it  is  now  at  work  on  a  plan  for  uniform 
reporting. 


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